Provider Demographics
NPI:1538375159
Name:SIELA, GARY DEAN (LMFT)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:DEAN
Last Name:SIELA
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8911 LAKEWOOD DR STE 24F
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CA
Mailing Address - Zip Code:95492-7856
Mailing Address - Country:US
Mailing Address - Phone:707-836-6350
Mailing Address - Fax:
Practice Address - Street 1:8911 LAKEWOOD DR STE 24F
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CA
Practice Address - Zip Code:95492-7856
Practice Address - Country:US
Practice Address - Phone:707-836-6350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC47106106H00000X
CA47106106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1538375159Medicaid